By Mario Senzale

“University Medical Center seeks healthy male volunteers aged 30 to 45 to participate in a research study investigating brain dynamics during sleep. The study involves one screening visit (about one hour) and three overnights (about 12 hours each) in our Sleep Research Lab. You will receive up to $900 total for participating in this study.”

I

The technician who prepared him had a name tag that read SARAH. Late twenties. She worked methodically, parting his hair to expose sections of scalp, applying the cold gel, pressing each electrode into place with a touch that was neither gentle nor rough. He watched her in the mirror mounted on the wall, absorbed entirely in the task of making his biology tractable. He closed his eyes. The cool pressure of the gel. The weight of her fingers against his skull. His brain attempted its familiar translation: protocol into care, procedure into touch. 

He was three when he got chickenpox. Fever climbing to 103°F, lesions spreading across his back and chest in angry bursts. His mother bought him a Goofy plush from Toys "R" Us, as tall as he was, with that idiotic grin and floppy ears. For three days she sat beside his bed rubbing calamine lotion into his skin in slow, methodical circles. He couldn't sleep but he didn't want to, he wanted to stay in that loop forever—itching, burning, her hand moving across his back. 

"You'll feel the wires," Sarah said, "but try to sleep normally. We're measuring REM cycles, sleep apnea indicators, restless leg syndrome markers."

"What if I can't sleep?"

"You’ll do fine." She attached the final sensor to his left temple. "There. Don't touch anything. If you need me, just call." She left him alone in the room. It was small and white and smelled of ether. A hospital bed with thin sheets, a blood pressure cuff mounted on the wall, a camera in the corner with a red light that would watch him through the night. He lay down carefully, feeling the pull of wires that connected him to banks of equipment in another room where Sarah - or some other Sarah - would monitor the electrical activity of his sleeping brain. 

He expected boredom, discomfort, the awkwardness of being watched. What he didn’t expect was the profound sense of relief that settled over him as he lay there. For the first time in years, someone was checking on him. Whether his heart was beating correctly. Whether he existed at all. He was no longer responsible for the surveillance of his own body. That had been outsourced to technicians who would note every irregularity in his breathing, every twitch of his legs, every transition between sleep stages. 

He did sleep. Comfortably. And when he woke—to fluorescent lights and Sarah returning to remove the sensors, peeling them away with careful efficiency—he felt an acute sense of loss. "How'd I do?" he asked. She smiled professionally. "The doctor will go over the results with you tomorrow." But he didn't care about results. He cared about the eight hours of being perfectly observed, his autonomy dissolved into medical attention.

He started looking for more trials—and he signed up for everything he qualified for. A study on caffeine's effects on reaction time. A trial of an experimental antihistamine. A weekend locked in a metabolic chamber while they measured his oxygen consumption. He was good at being a subject—compliant, reliable, his baseline vitals pleasingly normal. The research coordinators began to recognize him, greeting him by name when he showed up for new studies. He became a regular in the waiting rooms. "You do a lot of these," a coordinator named Michael commented once, reviewing his file before a glucose tolerance test. 

"Extra cash." 

"Sure." His pen paused on the form. He marked something in the file and told him not to eat anything after midnight.

The glucose test required him to drink a solution that was sickeningly sweet, then have his blood drawn every thirty minutes for three hours while they tracked how his body processed it. He sat in a recliner with a catheter in his arm and watched his blood fill vial after vial, dark red and warm. Each draw was noted on a chart. Sitting there, feeling the slight tug each time they accessed the port, watching the clock move toward the next scheduled draw, he understood something about himself that he hadn't figured out before. He craved monitoring. Someone checking his vitals, tracking every change in his body, making sure nothing went wrong. Someone to look over him.

II

He began to research medical procedures that weren't experimental. That existed in the ordinary infrastructure of healthcare but required justification. Surgeries. Transplants. Interventions reserved for bodies that had failed in specific ways. His apartment filled with medical textbooks purchased from used bookstores near the university. Harrison's Principles of Internal Medicine. The Merck Manual. Current Medical Diagnosis & Treatment. He read them the way other men read pornography: alone at night, searching for the mechanisms by which his urge could be satisfied.

Bradycardia. An abnormally slow heart rate, typically defined as fewer than sixty beats per minute at rest. Causes included hypothyroidism, electrolyte imbalances, certain medications, damage to the heart's electrical system. Symptoms: fatigue, dizziness, fainting. Treatment in severe cases: pacemaker implantation. He researched it methodically. Beta blockers would slow the heart but any competent doctor would test for that. Calcium channel blockers, the same problem. What he needed was something that would create the underlying condition rather than just masking it. Hypothyroidism. The thyroid gland regulated metabolism, and when it failed, everything slowed—including heart rate. Better yet, hypothyroidism could develop gradually, could be chalked up to autoimmune disease or idiopathic causes. And it could be induced.

Methimazole. An anti-thyroid medication used to treat hyperthyroidism—available without a prescription via Indiamart. He ordered a three-month supply, received it in discreet packaging, and began taking 30mg daily, a dose that would suppress thyroid function in someone with normal baseline activity without triggering immediate crisis. The effects developed slowly: fatigue, sluggish thinking, his hair thinning slightly, his skin becoming dry. His resting heart rate—monitored obsessively with a pulse oximeter from Turner Medical—began to drop: seventy… sixty-five… fifty-four.

He went to his primary care physician complaining of exhaustion and occasional dizziness. Dr. Patel, a woman in her fifties with kind eyes and terrible handwriting, ordered blood work. The results showed his TSH was elevated significantly, while his T3 and T4 levels were crashed. "We'll start you on levothyroxine," she said. "It should help with the symptoms." He filled in the prescription but didn't take the drug. Instead, he continued the methimazole. His heart rate dropped to fifty. Then forty-five. He began experiencing episodes where his vision would tunnel and darken at the edges, where he had to sit down at the risk of collapse. He went back to Dr. Patel. "The medication isn't working." She frowned, checked his refill history and nodded slowly. She ordered an EKG. 

He lay on the examination table while she placed electrodes across his chest, the cool gel making contact points on his skin. She wasn’t Sarah—neither gentle nor rough. Her touch carried the authority of someone in command—every press of her fingers made him aware of his body as hers to monitor. The machine produced its readout—a strip of paper covered in the characteristic spikes and valleys of cardiac electrical activity. His rhythm was slow but regular. Sinus bradycardia. Heart rate: forty-two. "I'm referring you to a cardiologist," she said. 

Dr. Morse was younger than Patel. More exacting. She ordered a Holter monitor. He went home with the device strapped to his chest, wires running to electrodes, the small recording unit clipped to his belt. For two days he was continuously monitored, his cardiac activity translated into data that would be analyzed for patterns, abnormalities, dangerous arrhythmias. He felt a slight satisfaction wearing it—muted by knowing no one was checking in real time. The results showed multiple episodes of heart rate dropping below forty, including one period during sleep where it had fallen to thirty-two. Dr. Morse showed him the printouts. "Your heart's electrical system isn't firing properly. Given your age and the severity, I'm recommending a pacemaker."

"Is that needed?"

"Your heart rate is too slow to perfuse your brain adequately. A pacemaker will ensure it doesn't drop below a safe threshold." Finally, someone else would hold the reins, his heart no longer his own. 

"How soon?" he asked, letting her concern register fully. 

Dr. Morse checked the database. "I can schedule it for next week." 

“That works.”

The implantation was performed in an outpatient surgical suite. They gave him local anesthetic and conscious sedation—enough that he was relaxed but aware. He lay on his back while Dr. Morse made an incision below his left clavicle, created a pocket in the tissue, and threaded leads through his subclavian vein into his heart. He watched on the fluoroscopy monitor as the leads advanced, wire shadows moving through the ghostly architecture of his chest. They positioned them carefully—one in the right atrium, one in the right ventricle—and tested the connections, sending electrical impulses that made his heart contract on command. 

They placed the pacemaker itself into the pocket they'd created, a small titanium device about the size of a silver dollar that would monitor his heart rate and provide impulses whenever it detected a rate below sixty. They sutured him closed, bandaged the incision, and moved him to recovery. 

One hour later, the sedation cleared. He became aware of the foreign object beneath his skin. He touched it carefully through the bandage. A machine, literally inside him, regulating his cardiac rhythm.

He was four when his mother was pregnant. He barely remembered it, just fragments. His brother, two years older than him, hit her stomach during an argument. Hard. That night, he heard screams and walked to his parents’ room. His mom was lying in bed, sheets stained red. The ambulance arrived. They left him alone in the house—he was too small. He cried himself to sleep on the carpet near the door. When they returned, his mother wasn't carrying anymore. His father brought a giant Garfield balloon, the kind with weights sewn into the paws so it stood upright. Orange and striped and grinning. He placed it beside his bed without saying a word. 

Dr. Morse called him in for a follow-up three weeks later. The incision healed well, leaving a thin scar. She interrogated the pacemaker with a specialized programmer, downloading data about his heart's activity since implantation. She frowned at the screen. "Your underlying rhythm is still very slow. The pacemaker is pacing you most of the time." She looked at him. "Your thyroid levels—did Patel start you on replacement therapy?" —"Yes." —"Are you taking it?" —"Every day." She pulled up his lab results. His TSH was still catastrophically elevated. "These numbers suggest you're not absorbing the medication… or you're taking something that's interfering with it." She paused. "Like what?" - "Certain supplements can block thyroid hormone absorption. Are you taking anything? Calcium? Iron?" —"Just some Flintstones gummies."

She studied him with an expression he recognized. "I'm going to be direct with you. The pattern I'm seeing, it suggests either a very unusual endocrine disorder or deliberate interference." He kept his face neutral. "I don't understand." —"Some patients develop what we call factitious disorders. They induce illness in themselves, consciously or unconsciously. I need to ask: have you been taking anything that might suppress your thyroid function?" —"I don’t think so." —"Because if you have, we need to address it. Not just medically but psychiatrically." —"I haven't." He met her eyes. "I just want to be fine." She held his gaze for a long moment. "I'm going to refer you to an endocrinologist. And I want you to see someone in our psychiatry department. Just to rule things out." He agreed to both referrals. He didn't keep either appointment. Instead, he stopped going to Dr. Morse. Stopped seeing Dr. Patel. He let his methimazole expire, allowed his thyroid to gradually recover, brought his heart rate back to something closer to normal, or as normal as it could be with a pacemaker intervening. He became, on paper, a patient who had stabilized and stopped following up—not suspicious enough to trigger mandatory psychiatric intervention, but marked in his medical record as non-compliant, possibly factitious. He knew what that meant. He was burned at this hospital system. They would question any future complaints, scrutinize any new symptoms. If he wanted to continue, he would need to start over somewhere else, with doctors who didn't know his history. 

He began researching hospitals in other states.

III

Portland, Oregon. He found a new primary care physician, Dr. Raymond Chen, and came in complaining of intermittent upper-right abdominal pain. Dr. Chen ordered an ultrasound of his gallbladder. It showed no stones, no obvious pathology. His liver enzymes were mildly elevated but within normal range. "Could be diet-related," Dr. Chen said. "Less fried food, more veggies. Some cardio wouldn't hurt—I do the elliptical myself, great for the joints." He tapped his knee. "If the pain continues, we'll do some more tests."

The pain did persist. He made sure it did. Acetaminophen, three grams a day. Sometimes four. He stayed just below the threshold that would trigger immediate crisis, supplementing it with alcohol to multiply the hepatotoxic effect. He bought kava supplements as well, research-grade doses that studies had linked to liver injury. 

Over the following months, the changes became visible. His urine began to darken. His skin took on a subtle yellow tone. The dull ache in his right side became constant. When Dr. Chen rechecked his labs, his expression changed. "I’m ordering a CT scan," he said. "Your ALT and AST are quite elevated. And your bilirubin is up." The CT scan showed hepatomegaly with diffuse fatty infiltration. His numbers continued to worsen. Dr. Chen referred him to a hepatologist. 

Dr. Wu specialized in liver disease. She took a detailed history, asked about his alcohol consumption (he admitted to social drinking, maybe two drinks a week), asked about medications and supplements (he mentioned the kava, expressed surprise when she told him it could be harmful). She ordered a liver biopsy. 

The procedure was done with local anesthesia, a needle inserted through his right side to extract a core of liver tissue. He felt the pressure, the strange deep ache as the needle penetrated. He held his breath. Dr. Wu's hands were steady as she worked. She smelled like lavender hand soap. The needle was inside him and she was concentrating entirely on the architecture of his organ. She took from his body what she needed, and he gave it willingly—a transaction more intimate than anything involving consent forms had a right to be. She analyzed the sample: severe steatohepatitis with bridging fibrosis. His liver was failing. "You need to stop all alcohol immediately," Dr. Wu said. "And discontinue the kava. If your liver function doesn't improve, we're looking at end-stage disease." He stopped the kava. He reduced his drinking to nearly nothing. But he continued the acetaminophen, hidden in his daily routine. Within eight months his MELD score had climbed high enough to qualify him for transplant evaluation.

Psychiatric clearance. Social work assessment. Financial review. Each gate designed to filter out patients who might waste a donor organ. He performed compliance perfectly: attended every appointment, answered every question appropriately, demonstrated understanding and commitment. The psychiatrist found him 'appropriate for listing with no significant psychopathology.' The social worker noted his stable employment and housing. He was approved.

He spent nine months on the waiting list. During that time his liver function deteriorated further. He developed ascites. His legs swelled. He became jaundiced, his skin and eyes visibly yellow. He felt, in some ways, more alive than he had ever been, his body failing in ways that were visible, measurable. One morning he stood in front of the bathroom mirror at his apartment. The jaundice had turned his skin a deep yellow-orange, almost luminous in the harsh fluorescent light. He remembered the Garfield balloon. 

The transplant was the most expensive gift he'd ever received. The call came at two in the morning. A liver was available, blood type compatible, reasonable match. He needed to come to the hospital immediately. Surgery took eight hours. They removed his cirrhotic liver and implanted the donor organ, connecting hepatic artery, portal vein, bile duct. He woke in the ICU with a ventilator tube down his throat, drains coming out of his abdomen, IV lines in both arms and his neck. He couldn't speak but he could register the intensive monitoring—nurses checking vitals every fifteen minutes, adjusting medications, documenting his recovery. He was in the deepest embrace of medical care he had ever experienced.

They extubated him after thirty-six hours. He spent a week in the hospital, then was discharged with immunosuppressants he would take for the rest of his life. He took them faithfully—he wanted the transplant to succeed. But success meant less monitoring. When the doctors said, 'You're doing great, you'll be going home soon,' he felt the panic of being left alone again.

IV

For a year he lived with his transplanted liver, attending follow-up appointments, having his immunosuppressant levels checked, getting periodic biopsies to ensure the organ wasn't being rejected. His new liver functioned well. His MELD score normalized. He returned to work full-time. The transplant had been dramatic but it was curative—they fixed him, sent him home, stopped watching. What he longed for was palliative care. To access the monitoring infrastructure reserved for people with significant medical risk. Experimental protocols that required patients to be observed continuously, their bodies translated into data streams that someone, somewhere, would watch in real time. Cancer. That was the door he needed to walk through. But not just any cancer, it had to be the right kind, aggressive enough to require experimental treatment but slow enough to give him time to enroll in trials.

He researched oncology like he had researched cardiology and hepatology before it. Studied incidence rates, mortality statistics, treatment protocols. He learned about CAR-T cell therapy, checkpoint inhibitors, tumor-infiltrating lymphocyte therapy. Treatments that were only approved for specific cancer types, that required patients to have failed conventional chemotherapy first. Non-Hodgkin's lymphoma appeared in his research repeatedly. It was one of the cancers with the most active experimental pipelines, particularly for aggressive subtypes. And crucially, there was epidemiological data linking it to glyphosate exposure - the active ingredient in Roundup. The mechanism wasn't entirely understood, but the correlation was strong enough that Monsanto had lost multiple lawsuits. Agricultural workers exposed to glyphosate over years showed elevated rates of non-Hodgkin's lymphoma. Which suggested that concentrated exposure over months might accomplish what years of agricultural work.

He bought a humidifier designed for large rooms and three bottles of Roundup concentrate. At night he mixed forty milliliters into the water reservoir, sealed his bedroom door and windows, and set the humidifier to run on schedule: from 11 PM to 7 AM. He slept in a cloud of aerosolized glyphosate, breathing it deeply for eight hours every night.

The first week he noticed mild irritation in his throat. By week two he developed a persistent cough. Week three brought fatigue that his morning coffee couldn't quite fix. Week four his lymph nodes began to swell, first the ones in his neck, then his armpits, his groin. Small lumps he could feel under his skin. He touched them obsessively. Measured them with digital calipers. Kept a log. By day fifty-six he made an appointment with Dr. Chen, presenting with the most obvious symptoms: the swollen lymph nodes, the unexplained weight loss, the fevers and night sweats. Dr. Chen palpated his neck and found the enlarged nodes immediately. 

"How long have you had these?"

"I noticed them maybe three weeks ago. I think they’re getting bigger."

Dr. Chen's expression was grave. "I'm ordering labs and imaging today. These could be from an infection, but given your systemic symptoms, we need to rule out lymphoma." The blood work showed anemia, elevated LDH, abnormal white cell counts. The CT scan revealed extensive lymphadenopathy. Dr. Chen referred him to an oncologist. 

Dr. Torres performed the biopsy in his office, using local anesthesia to numb the area before removing one of the cervical lymph nodes entirely for analysis. The pathology report came back five days later: diffuse large B-cell lymphoma, an aggressive form of non-Hodgkin's lymphoma with a high proliferation rate. He delivered the diagnosis in an examination room painted calming blue. "This is a serious cancer, but it's also one we have good treatment options for. The standard approach is R-CHOP chemotherapy, a combination of drugs that's very effective for it."

"Will I be fine?"

"Well, with treatment, the five-year survival rate is around sixty percent. Without treatment..." He paused. "This type of lymphoma is aggressive. Median survival without treatment is months."

"What about clinical trials?"

Dr. Torres looked interested. "CAR-T cell therapy is showing remarkable results for relapsed or refractory cases. There are also trials combining checkpoint inhibitors with chemotherapy. But, typically, we start with standard treatment and only move to experimental protocols if the cancer doesn't respond."

"Sounds good. I’d like to keep everything on the table."

"I would too. Let me connect you with our research coordinator. In the meantime, we should start staging workup and get you scheduled for chemo."

The staging showed extensive disease: stage IV, with bone marrow involvement and multiple extranodal sites. Aggressive lymphoma spreading through his body with engineered efficiency.

V

Chemotherapy hit hard—nausea, fatigue, hair loss. His white blood cell count dropped, leaving him immunocompromised. The cancer responded initially—lymph nodes shrinking after three cycles. But between cycles four and five, his blood counts failed to recover. The cancer found its opening. "We need to look at alternatives," Dr. Torres said. "Your cancer is refractory now, which makes you eligible for clinical trials." The research coordinator presented options. He chose CAR-T—not because it was the most effective, but because it required ICU-level monitoring. 

The leukapheresis took four hours, his blood flowing through the apheresis machine, T cells extracted. Then, conditioning chemotherapy to ablate his immune system. His counts crashed. Mucositis made swallowing agony. He was admitted in protective isolation: positive pressure room, visitors gowned and gloved. Two weeks connected to IV nutrition, blood counts checked twice daily. The CAR-T cells arrived on a Friday. Dr. Torres explained they would expand in his body over the next week, attacking his cancer, potentially triggering severe side effects. Continuous monitoring. The infusion took fifteen minutes. His fever spiked to 103°F. Blood pressure dropped. He became confused, couldn't remember where he was. They transferred him to the ICU, started vasopressors, gave him tocilizumab to block the inflammatory cascade. Through the fog: a nurse holding his hand while adjusting the drip. Another wiping his forehead with a cool cloth. "You're doing great, just keep breathing." Even when he couldn't understand what was happening, he understood someone was there. Monitoring.

When the fever broke, they told him he'd been close to intubation. That his oxygen had dropped dangerously low. That the CAR-T cells had expanded dramatically and were working - lymph nodes shrinking in real time. Remission. But the CAR-T cells had destroyed his B cells. He would require monthly immunoglobulin infusions indefinitely. His immune system would remain compromised for months, possibly years. Someone would have to watch him for the rest of his life.

VI

Three months post-CAR-T, he sat in a wheelchair in the infusion center. His legs worked but his energy didn't. The aide pushed him from waiting room to infusion bay. He was bald, forty pounds lighter, his body wasted. The port beneath his right chest was visible when the nurse accessed it for the immunoglobulin. It was December 21st. Paper snowflakes on windows, a small artificial tree with slow-blinking lights, garland along the nurses' station. Diana accessed his port, positioned the thermal blanket how he liked it, left his right arm free. "Comfortable?" He nodded. The immunoglobulin began to flow. Halfway through, someone from hospital auxiliary appeared with a cart. An older woman in a red vest. She was distributing wrapped gifts to the patients in the infusion center.

"Merry Christmas," she said, stopping at his chair. "Would you like to pick one?"

"Go ahead," Diana said, adjusting his IV rate. 

He reached for a soft package, medium-sized, wrapped in blue paper with silver stars. He tore the paper carefully, folded it into a neat square and set it on the side table. Inside was a plush dog. Brown with floppy ears, black button eyes. He held it in his lap. "That's cute," Diana said, checking his port site. "What are you going to name him?" He didn't answer. He ran his thumb over one of the floppy ears. 

Mario Senzale is a South American writer and mathematician currently living in Indianapolis, Indiana. His stories have been published in multiple magazines including Expat Press, JMWW, Tension Lit, Last Girls' Club, and Horrific Scribes. He is currently working on his first short story collection, Everything Costs and Nobody Got.